Rectal Prolapse

Rectal prolapse is a condition in which the rectum (the lower end of the colon, located just above the anus) turns itself inside out. In the earliest phases of this condition, the rectum does not stick out of the body, but as the condition worsens, it may protrude. Weakness of the anal sphincter muscle is often associated with rectal prolapse at this stage and may result in leakage of stool or mucus. The condition occurs in both genders, although it is more common in women than men.

Causes

Several factors may contribute to the development of rectal prolapse. It may come from a lifelong habit of straining to have bowel movements or as a delayed result of stresses involved in childbirth. In rare cases, there may be a genetic predisposition in some families. It seems to be a part of the aging process in many patients who experience weakening of the ligaments that support the rectum inside the pelvis as well as loss of tightness of the anal sphincter muscle. In some cases, neurological problems, such as spinal cord transection or spinal cord disease, can lead to prolapse. In most cases, however, no single cause can be identified.

Is rectal prolapse the same as hemorrhoids?

While some of the symptoms may be the same, such as bleeding or tissue that protrudes from the rectum, rectal prolapse is different from hemorrhoids as it involves a segment of the bowel located higher up within the body than hemorrhoids which develop near the anal opening.

Symptoms

Symptoms of rectal prolapse may include:

  • A mass that comes out of the anus, often while straining during a bowel movement. The mass may slip back inside the anus, or it may remain visible
  • The inability to control bowel movements (fecal incontinence)
  • Constipation or diarrhea
  • Leaking blood or mucus from the rectum
  • Feeling that your rectum isn't empty after a bowel movement
Diagnosis

Your physician can diagnose rectal prolapse condition by taking a careful history and performing an anorectal examination. To demonstrate the prolapse, patients may be asked to "strain" as if having a bowel movement or to sit on the commode and "strain" prior to examination. At times, however, a rectal prolapse may be "hidden" or internal. In this situation, an X-ray examination called a videodefecogram may be helpful. This examination, which takes X-ray pictures while the patient is having a bowel movement, can also assist the physician in determining whether surgery may be beneficial and which operation may be appropriate. Anorectal manometry may also be used. This test measures whether or not the muscles around the rectum are functioning normally.

Treatment

Although constipation and straining may be causes of rectal prolapse, simply correcting these problems may not improve the prolapse once it has developed. There are many different ways to surgically correct rectal prolapse.

Abdominal or perineal surgery may be suggested. Our experienced team can assist in determining which method is best, based on the test results, extent of prolapse and patient health. If anal muscle strength has been compromised due to the prolapse, in many cases strength may be regained after corrective procedures.

For future success, chronic constipation and straining after surgical correction must be avoided. A great majority of patients are completely relieved of symptoms, or are significantly helped, by the appropriate procedure.